(1) Agency

Transportation

(2) I.D. Number (Governor's Office Use)

#18-402

This spac Jltf-sbe by ittRC -J

m m 2 5 m.2:09

IRRC Number: J Y ^ ^ L .

(3) Short Title

School Bus Drivers

(4) PA Code Cite '

67 Pa. Code, Chapter 71

(6) Type ofRulemaking (Check One)

_ Proposed RulemakingX Final Order Adopting Regulation

Final Order, Proposed Rulemaking Omitted

(5) Agency Contacts & TelephoneNumbers

Primary Contact: Janet Dolan(717)787-4701

Secondary Contact: Chris A. Miller(717)787-6453

(7) Is a 120-Day Emergency CertificationAttached?

X NoYes: By the Attorney GeneralYes: Bv the Governor

(8) Briefly explain the regulation in clear and nontechnical language.

The purpose of these amendments is to allow chiropractors to administer the physical examinationrequired for school bus drivers. Pennsylvania law requires a school bus driver to have a physicalexamination every year.

(9) State the statutory authority for the regulation and any relevant state or federal court decisions.

Authority for this regulation is contained in § 1509 of the Vehicle Code, Act of June 17,1976,P.L. 162, as amended (75 Pa.C.S. § 1509).

(10) Is the regulation mandated by any federal or state law or court order, or federal regulations?If yes, cite the specific law, case or regulation, and any deadlines for action.

Act 76 of 2004 amended 75 Pa.C.S. § 1508.1 requiring the Department to promulgate regulationsto authorize specific classes of licensed practitioners of the healing arts to conduct examinationsrequired for the issuance of a driver's license and a school bus driver endorsement.

(11) Explain the compelling public interest that justifies the regulation. What is the problem itaddresses?

Pennsylvania law requires a school bus driver to have a physical examination. According toexisting regulations the only health care providers who can perform that physical are a licensedphysician, a certified registered nurse practitioner or a physician's assistant. Chiropractorsare currently considered by health insurance companies to be portal of care practitioners. Thismeans they are regarded as primary care physicians, permitted to furnish necessary patient carefor health maintenance. Chiropractors are also allowed, by federal regulation, to conduct themedical examinations for commercial drivers required every two years by the Federal HighwayAdministration under Motor Carrier Safety regulations. Since the exclusion of chiropractorsfrom the list of health care providers is inconsistent with current health care practices andfederal regulations, chiropractors should be added to Pa. Code Title 67, Chapter 71 as one ofthe providers who can give the physical examination for the school bus driver endorsement.

(12) State the public health, safety, environmental or general welfare risks associated with non-regulation.

Failure to amend these regulations will continue to prohibit chiropractors from performing theschool bus driver physical examination.

(13) Describe who will benefit from the regulation. (Quantify the benefits as completely aspossible and approximate the number of people who will benefit.)

Individuals who use a chiropractor as their primary care physician will be able to get theexamination from that physician. Chiropractors may benefit by being able to give theexamination. The precise number of individuals who will benefit cannot be determined.

(14) Describe who will be adversely affected by the regulation. (Quantify the adverse effects ascompletely as possible and approximate the number of people who will be adversely affected.)

There should be no adverse impact on any individuals from this amendment to the regulation.

(15) List the persons, groups or entities that will be required to comply with the regulation.(Approximate the number of people who will be required to comply.)

It is not known precisely how many individuals will be required to comply. In addition tochiropractors, school districts and independent contractors operating school buses or school bus

Page 2

services will be required to comply with this regulation. Pennsylvania has 501 public schooldistricts and over 2,000 private schools.

(16) Describe the communications with and input from the public in the development and draftingof the regulation. List the persons and/or groups who were involved, if applicable.

These proposed amendments are the result of in-depth discussions with the PennsylvaniaChiropractic Association.

(17) Provide a specific estimate of the costs and/or savings to the regulated community associatedwith compliance, including any legal, accounting or consulting procedures which may be required.

"The~costs~and/oT savings"to theregulated community resulting from these amendments aremarginal and cannot be calculated with any precision.

(18) Provide a specific estimate of the costs and/or savings to local governments associated withcompliance, including any legal, accounting or consulting procedures which maybe required.

There should be no costs and/or savings to local governments resulting from these amendments tothe regulation.

(19) Provide a specific estimate of the costs and/or savings to state government associated with theimplementation of the regulation, including any legal, accounting, or consulting procedures whichmay be required.

There should be no costs and/or savings to state government resulting from these amendments tothe regulation.

(20) In the table below, provide an estimate of the fiscal savings and costs associated withimplementation and compliance for the regulated community, local government, and stategovernment for the current year and five subsequent years.

SAVINGS:

Regulated Community:

Local Government:

State Government:

Current FYYear

$N/A

N/A

N/A

N/A

F Y + 1Year

$

F Y + 1Year

$

FY + 3

$

FY + 4Year

$

FY + 5Year

$

Total Savings

COSTS:

Regulated Community

Local Government

State Government

Total Costs

REVENUE LOSSES:

Regulated Community

Local Government

State Government

Total Revenue Losses

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

-N/A

N/A

N/A.

—

(20a) Explain how the cost estimates listed above were derived.

(20b) Provide the three year expenditure history for programs affected by the regulation.

Program

Appropriation183

FY-3

$118,558,000

FY-2

$124,925,000

FY-1

$ 125,958,000

Current FY

$129,459,000

(21) Using cost-benefit information provided above, explain how the benefits of theregulation outweigh the adverse effects and costs.

N/A

(22) Describe the nonregulatory alternatives considered and the costs associated with those

alternatives. Provide the reasons for their dismissal.

There were no nonregulatory alternatives considered. The change in the health carepractitioners who could give the physical examination could not be effected withoutamendment of the regulation.

(23) Describe alternative regulatory schemes and the costs associated with those schemes.Provide the reasons for their dismissal.

No alternative regulatory schemes were considered.

(24) Are there any provisions that are more stringent than federal standards? If yes, identifyIhl>ipeci5cp that demands stronger-regulation.

There are no applicable federal standards governing the state's licensing of drivers.

(25) How does this regulation compare with those of other states? Will the regulation putPennsylvania at a competitive disadvantage with other states?

This regulation will not put Pennsylvania at a competitive disadvantage vis a vis other states.

(26) Will the regulation affect existing or proposed regulations of the promulgating agency orother state agencies? If yes, explain and provide specific citations.

These amendments will not affect other Department regulations or the regulations of any otherCommonwealth agency.

(27) Will any public hearings or informal meetings be scheduled? Please provide the dates,times and locations, if available.

No public hearings on these amendments are scheduled at this time. Should public commenton these proposed amendments warrant, public hearings may be held.

(28) Will the regulation change existing reporting, record keeping, or other paperworkrequirements? Describe the changes and attach copies of forms or reports which will berequired as a result of implementation, if available.

These amendments will not change any paperwork requirements.

(29) Please list any special provisions which have been developed to meet the particular needsof affected groups or persons including, but not limited to, minorities, elderly, smallbusinesses, and farmers.

These amendments are all designed to meet the particular needs of individuals who use achiropractor as their primary care physician.

(30) What is the anticipated effective date of the regulation; the date by which compliancewith the regulation will be required; and the date by which any required permits, licenses orother approvals must be obtained?

These amendments will become effective upon publication in final form in the PennsylvaniaBulletin

(31) Provide the schedule for continual review of the regulation.

These provisions will be reviewed periodically as appropriate by the Department and theDepartment's Medical Advisory Board.

RECEIVED

FACE SHEET IFOR FILING DOCUMENTS

WITH THELEGISLATIVE REFERENCE BUREAU

(Pursuant to Commonwealth Documents Law)

Copy below is hereby approved as to form and legality.Attorney General.

(Deputy Attorney General)

Date of Approval

• Check if applicableCopy not approved. Objections attached.

DO NOT WRITE IN THIS SPACE

Copy of below is hereby certified to be true andcorrect copy of a document issued, prescribed orpromulgated by. - /

<rDepartment ?*

ofTransDortation

(Agency)

DOCUMENT/FISCAL NOTE NO. # 1 8 - 4 0 2

DATE OF ADOPTION

BY f^6^_ / ^ . ^ 2 ^ & ^Secretary of Transportation

/fcopy below is hereby approved as to

' / form and lejajjjyj>»sgtiveor

BY fataCChrfCJUN .2 0- 2007 •

(Date of Approval)

(Deputy General Counsel)

(Strike Inapplicable Title)

• Check if applicable. No attorney

General Approval or Objection within

30 days after submission.

NOTICE OF FINAL RULEMAKING

DEPARTMENT OF TRANSPORTATION

Title 67. Transportation

Part I. Department of Transportation

Subpart A. Vehicle Code Provisions

Article IV. Licensing

Chapter 71. School Bus Drivers

Title 67. TransportationPart I. Department of TransportationSubpart A. Vehicle Code Provisions

Article IV. LicensingChapter 71. School Bus Drivers

Notice of Final Rulemaking

List of Commenters

Rosemary Chiavetta, EsquireChiavetta Consulting

on behalf ofPennsylvania Chiropractic Association

800 North Third Street, Suite 102Harrisburg, Pennsylvania 17102

Gary S. Horwin, DC, PresidentChiropractic Fellowship of Pennsylvania

908 North Second StreetHarrisburg, Pennsylvania 17102

William L. Larder, MD, PresidentPennsylvania Medical Society

777 East Park DriveP.O. Box 8820

Harrisburg, Pennsylvania 17105-8820

John S. Jordan, CAE, Executive Vice PresidentPennsylvania Academy of Family Physicians Foundation

2704 Commerce Drive, Suite AHarrisburg, Pennsylvania 1/7110

George Thomas, DO, PresidentAmerican Osteopathic Association

142 East Ontario StreetChicago, Illinois 60611-2864

Hugh E. Palmer D.O., PresidentPennsylvania Osteopathic Medical Association

1330 Eisenhower BoulevardHarrisburg, Pennsylvania 17111-22395

Title 67. Transportation

Par t i . Department of Transportation

SubpartA. Vehicle Code Provisions

Article IV. Licensing

Chapter 71. School Bus Drivers

Notice of Final Rulemaking

Preamble

Notice is hereby given that the Department of Transportation, pursuant to the

authority contained in Section 1509 of the Vehicle Code, Act of June 17,1976, P.L. 162,

No. 81, as amended (75 Pa.C.S. §1509), hereby amends Chapter 71 of the Department of

Transportation Regulations, Title 67, by amending §§71.2 and 71.3, asset forth in

Annex A to this Notice.

Purpose of Chapter

The purpose of Chapter 71 is to define more fully the requirements of 75 Pa.C.S.

§ 1509 by listing minimum medical requirements for school bus drivers.

Purpose of the Proposed Amendments

The purpose of these amendments to Chapter 71 is to allow chiropractors to

administer the physical examination required for school bus drivers. Pennsylvania law

requires a school bus driver to have a physical examination every year. According to

Department regulations the only health care providers who can perform that physical are

licensed physicians, certified registered nurse practitioners or physician's assistants. The

Pennsylvania Chiropractic Association has requested chiropractors also be allowed to

conduct physicals as part of the process of obtaining a driver's license.

Preamble67 Pa. Code, Chapter 71

School Bus Drivers

Chiropractors are currently considered by health insurance companies to be portal of care

practitioners. This means they are regarded as primary care physicians, permitted to

furnish necessary patient care for health maintenance. They are also allowed, by federal

regulation, to conduct the medical examinations for commercial drivers required every

two years by the Federal Highway Administration under Motor Carrier Safety

regulations. Since the exclusion of chiropractors from the Department's list of health

care providers is inconsistent with current health care practices and federal regulations,

chiropractors should be added to Pa. Code Title 67, Chapter 71 as one of the providers

who can give the school bus driver's physical examination.

Summary of Comments and Changes in Final Adopted Regulation

Public comment was received from the Pennsylvania Medical Society (PMS), the

Pennsylvania Academy of Family Physicians Foundation (PAFPF), the American

Osteopathic Association (AOA), and the Pennsylvania Osteopathic Medical Association

(POMA) objecting to the inclusion of Chiropractors as medical professionals authorized

to conduct examinations required for the school bud driver endorsement. These

organizations argue that Chiropractors are not medically qualified to conduct the basic

medical examination required under the Vehicle Code. They argue that Chiropractors

lack the training and experience of Physicians and Doctors of Osteopathy to make

sophisticated diagnoses.

The objections overstate the sophistication of the basic medical examination

required under the Vehicle Code. Moreover, these amendments to the Chapter 75 merely

conform the regulation to include the authorization of Chiropractors to conduct the

Preamble67 Pa. Code, Chapter 71

School Bus Drivers

required examinations which has already been authorized in the 2004 amendments to the

Vehicle Code enacted by the General Assembly and signed by the Governor.

The requirements of 75 PA. C.S. § 1509(b) do not set up any separate physical

examination for school bus drivers; rather they require that school bus drivers carry proof

that they have passed the physical examination required of all drivers under § 1508.1. It

is this section (1508.1) that the General Assembly amended to include chiropractors in

"TBelisT of meTiicarpfofessionalnauthorized^toconductth&examination.

The comments of PMS suggest that additional disclaimer language be added to

note that there are some symptoms and conditions that may be beyond the training and

experience of chiropractors to diagnose. It should be noted that there may also be

symptoms or conditions which are beyond the training and experience of physician

assistance and nurse practitioners. And although such professional may typically work in

some collaboration with physicians, the General Assembly has placed no restriction on

those professionals that the required examination must be given in collaboration with a

physician. The Department declines to implicitly restrict the authority of chiropractors

under § 1508.1 by adopting the PMS suggested disclaimer.

The Independent Regulatory Review Commission (IRRC) commented that the

new definition of "Doctor of Chiropractic Medicine" differed from the definition of

"chiropractor" in the Vehicle Code. It was recommended that the rulemaking be revised

to conform verbatim to the definition of "chiropractor" in the statute or be replaced by a

reference to the statutory definition. The recommended change to the reference the

statutory definition of "chiropractor" has been made. This change should also resolve the

concerns raised by the Chiropractic Fellowship of Pennsylvania that the definition in the

Preamble67 Pa. Code, Chapter 71

School Bus Drivers

proposed rulemaking unreasonably restricted the authority to conduct the examination to

a subset of chiropractors. In response to this concern, the reference to "Doctor of

Chiropractic Medicine" in § 71.3 has also been changed &) "chiropractor."

In addition, IRRC questioned the continued use of the term "school transportation

physician" and suggested that it could be deleted. The Department believes that the

authority of school districts to designate a specific medical practitioner to conduct the

physical examination of school bus drivers should be retained. To address the concerns

raised by IRRC, and to provide further clarification in the regulation, the Department has

included a definition of "physician" in the final rulemaking and amended to definition of

"school transportation physician" to be "school transportation medical practitioner" and

included physicians, chiropractors certified nurse practitioners and physician assistants as

the medical professionals who could be so designated by a school district.

The IRRC comments also noted that § 71.3(c) needed to be amended to include

chiropractors in the list of practitioners in that section. That change has also been made.

Finally, Rosemary Chiavetta, Esquire, on behalf of the Pennsylvania Chiropractic

Association, submitted comments supporting the rulemaking.

Persons and Entities Affected

These regulations affect all licensed school bus drivers or persons interested in

becoming a school bus driver and chiropractors.

Fiscal Impact

Implementation of these regulations will not require the expenditure of any

additional funds by the Commonwealth or local municipalities. These regulations will

not impose any additional costs on the medical community and may reduce costs by

Preamble67 Pa. Code, Chapter 71

School Bus Drivers

allowing applicants for a learner's permit to get their physical examination from their

primary care physician.

Regulatory Review '

Under Section 5(a) of the Regulatory Review Act (71 P.S. 745.5(a)), the

Department submitted a copy of the notice of proposed rulemaking, published at 35 Pa.B.

3145, to the Independent Regulatory Review Commission (IRRC) and to the

"Chairpersons of"the Mouse and^S^ate^ansportation^eoTnmitteesfor review and

comment.

In preparing this final-form rulemaking, the Department has considered all

comments received from IRRC and the public; no comments were received from the

committees. o

Under section 5.1 (j .2) of the Regulatory Review Act, on • 2007, this

final-form regulation was deemed approved by the House and Senate Transportation

Committees. Under section 5.1 (e) of the Regulatory Review Act, IRRC met on

, 2007 and approved the final-form regulation.

Sunset Provisions

The Department of Transportation will make these regulations effective upon

publication in final form following appropriate evaluation of any comments, suggestions

or objections received during the period allowed for public comment. The Department is

not establishing a sunset date for these regulations, since these regulations are needed to

administer provisions required pursuant to the Vehicle Code (75 Pa. C.S. 1.01, et seq.).

The Department, however, will continue to closely monitor these regulations for their

effectiveness.

Preamble67 Pa. Code, Chapter 71

School Bus Drivers

Contact Person

The contact person for technical questions about the proposed amendments to the

regulations is Chris A. Miller, Manager, Special Driver Programs, Department of

Transportation, Bureau of Driver Licensing, 1101 S. Front Street, 3rd floor, Harrisburg,

Pennsylvania 17106, telephone number: (717) 787-6453.

(A) The regulations of the Department of Transportation, 67 Pa. Code, are amended

by the adoption of amendments to Chapter 71 as set forth in Annex A.

(B) The Secretary of the Department of Transportation shall submit this Order and

Annex A hereto the Office of General Counsel and the Office of Attorney General for

approval as to legality and form, as required by law.

(C) The Secretary shall certify this Order and Annex A and deposit the same with the

Legislative Reference Bureau, as required by law.

(D) This Order shall take effect upon publication in the Pennsylvania Bulletin.

Allen D. Biehler, P.E.Secretary of Transportation

Preamble67 Pa. Code, Chapter 71

School Bus Drivers

ANNEXA

Title 67. Transportation

Part I. Department of Transportation

SubpartA. Vehicle Code Provisions

Article IV. Licensing

Chapter 71. School Bus Drivers

§ 71.2. Definitions.

The following words and terms, when used in this chapter, have the following

meanings, unless the context clearly indicates otherwise:

* * * * *

CHIROPRACTOR—A PRACTITIONER OF CHIROPRACTIC.AS DEFINED

IN SECTION 1508.1(B) OF THE VEHICLE CODE, 75 PA. C.S. § 1508.1(B).

Doctor of Chiropractic Medicine a person licensed in this Commonwealth who

has achieved certification or diplomate status through a program by an approved

chiropractic college that has established valid standards acceptable to the State Board

of Chiropractic for the achievement of certification or diplomate status and is able-te

diagnose and treat patients whose health problems are associated with the body's

muscular, nervous, and skeletal systems, especially the spine.

PHYSICIAN— A LICENSED PHYSICIAN AS DEFINED IN 67 PA. CODE §

83.2 (RELATING TO DEFINITIONS.

Annex A67 Pa. Code, Chapter 71

School Bus Drivers

* * * * *

School transportation physician MEDICAL PRA CTITIONER — A licensed

physician as defined in § 83.2 (relating to definitions), PHYSICIAN ASSISTANT,

CERTIFIED REGISTERED NURSE PRACTITIONER OR CHIROPRACTOR

appointed or approved by a school board, or by the authorities responsible for

operation of a private or parochial school. The same person may be appointed or

approved as both school transportation physician MEDICAL PRACTITIONER and

school physician MEDICAL PRACTITIONER.

§ 71.3. Physical examination.

(a) General rule. A physical examination shall be given by a school transportation

MEDICAL PRACTITIONER, a physician, a Doctor of Chiropractic Medicine

CHIROPRACTOR, a CRNP or a physician assistant:

(c) Physical examination certificate. The examining school transportation

MEDICAL PRACTITIONER, physician, CHIROPRACTOR, CRNP or physician

assistant shall issue a certificate, valid for the ensuing year, to every driver who passes a

physical examination.

Annex A67 Pa. Code, Chapter 71

School Bus Drivers

COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF TRANSPORTATION

OFFICE OF CHIEF COUNSEL

GENERAL LAW DIVISION

POST OFFICE Box 8212HARRISBURG, PA 17105-8212TELEPHONE: (717) 787-5299

FACSIMILE: (717) 772-2741GOVERNOR'S OFFICE OF

GENERAL COUNSEL

June 25, 2007

Kim KaufmanExecutive Director14th Floor Harristown 2333 Market StreetHarrisburg, PA 17101

Re: Final RulemakingRegulation # 18-402,67 Pa. Code Chapter 71 —School Bus Drivers

Dear Mr. Kaufman:

Enclosed please find a copy of the Face Sheet, Preamble, Annex A andRegulatory Analysis Form for amendment to Chapter 71 of Department regulationswhich the Department of Transportation intends to adopt in accordance with theprovisions of Section 204 of the Commonwealth Documents Law, Act of July 31, 1968,PL. 769, 45 PS. § 1204. The regulatory package submitted on June 21,2007 shouldbe considered withdrawn and this package submitted in its place.

The new regulatory package is identical to the earlier package except for arevision to page 2 of the Annex A.

Copies of these resubmitted materials were also delivered today to the majorityand minority chairpersons of the Pennsylvania Mouse and Senate TransportationCommittees.

requireThe Department of Transportation will provide you with any assistance youto facilitate a thorough review of this regulation. Thank you for your attention.

Very truly yours,

Stephen F. J. MartinRegulatory Counsel

COMMONWEALTH KEYSTONE BUILDING • 9TH FLOOR-400 NORTH STREET • HARRISBURG, PA 17120-0096

TRANSMITTAL SHEET FOR REGULATIONS SUBJECT TO THEREGULATORY REVIEW ACT

I.D. NUMBER:

SUBJECT:

AGENCY:

#18-402

67 Pa. Code Chapter 71 — School Bus Drivers

Department of Transportation

TYPE OF REGULATION

DATE SIGNATURE DESIGNATION

£H1

n

-^VvJ A X JJ^J)j ̂for Majority Chair

SENATE COMMITTEE ONTRANSPORTATION

for/pnority Chair

6.J&O7 / ^ _ ^ j 2 _ ^ ^ ^ H O U S E COMMITTEE ONfor Majority Chair ^

" for Minority Chair

TRANSPORTATION

uj^oi L^4&-&m

m

INDEPENDENT REGULATORYREVIEW COMMISSION

LEGISLATIVE REFERENCEBUREAU

30m

Proposed Regulation

X Final Regulation

Final Regulation with Notice of Proposed Rulemaking Omitted

120-day Emergency Certification of the Attorney General

120-day Emergency Certification of the Governor

FILING OF REGULATION

JO

June 25, 2007